Feedback—Your FAQs Answered—What effect good or bad, can a GI diet have on prostate cancer patients undergoing hormone treatment to limit testosterone?—I enjoy brown rice and always assumed it had a lower GI than any kind of white rice, but I see that Basmati’s is lower. Why’s that?—Does it matter if you eat carbs after 5pm? Will this affect your fat metabolism?—Dispelling Some Myths About Hypoglycemia

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Want to search the GI News Archive for a particular topic, food or recipe? Make the most of our search feature with Google. Simply enter the term in the space provided and press SEARCH.GI News Editor: Philippa SandallWeb Design and Management: Scott Dickinson

People Power for People with DiabetesIn February GI News, Atarah Grysman made the point that: ‘Many people today are ready and willing to be active participants in their own health care. They want to learn more about their conditions and how to manage them, even if this entails more than a few simple rules, and requires a deeper understanding of how their body works.’

The findings of a study by Johanna Burani of Nutrition Works in New Jersey and Dr Palma Longo of the University of Massachusetts in The Diabetes Educator (Volume 32, Number 1, January/February 2006 ) confirm this point. In a small retrospective study to evaluate the incorporation of low-GI carbohydrates into daily meal planning as an effective behavioural lifestyle change for people with type 1 and type 2 diabetes, the authors found that in most cases, patients were keen to succeed in their diabetes self-management care. And they were successful too. The participants in the study reduced HbA1c by an average of 19% and BMI by 8% simply by lowering the GI of their meals by 25% (15 points) over the period of the survey (3 to 36 months). Once presented with basic information about incorporating low-GI carbohydrates in meal planning, they made their own decisions and over time converted this dietary change into a way of life to improve their overall glycemia and preserve quality of life say the authors. They report that ‘learning to incorporate low-GI carbohydrates affords patients a practical skill that is within their grasp. It empowers them to “own” their diabetes and actively contribute to their control over it … The documented responses to the subjects’ conceptual and practical knowledge of the GI confirm their acceptance of this approach as a permanent behavioral lifestyle change and not a diet.’

Making the Switch, Making a DifferenceStudies are showing that metabolic syndrome or insulin resistance syndrome is widespread among adults in developed nations, with estimates in Australia alone for example of one in two adults over 25 years having at least two features of what is seen to be a silent disease. People with metabolic syndrome are three times as likely to have a heart attack or stroke compared with people without the syndrome and they have a five-fold greater risk of developing type 2 diabetes (if it’s not already present). David E Laaksonen and his team from Finland report in the American Journal of Clinical Nutrition that a simple dietary modification may lower the risk of developing type 2 diabetes in people with metabolic syndrome by enhancing early insulin secretion. They assigned 72 overweight or obese men and women with the metabolic syndrome to a 12-week diet in which either rye bread and pasta or oat and wheat bread and potato were the main carbohydrate sources (34% and 37% of energy intake, respectively). Body weight did not significantly change in either group during the trial. However, only the pasta-based carbohydrate modification enhanced early insulin secretion (by 33%) and was associated with improved glucose tolerance reducing the risk for the development of type 2 diabetes.—American Journal of Clinical Nutrition. 82(6):1218-278, 2005 Dec

Risk AssessmentReduce blood glucose (sugar) levels and you’ll reduce the risk of coronary heart disease reported Elizabeth Selvin and her colleagues in Archives of Internal Medicine (September 2005; 165, pp1910-1916). ‘For non-diabetics, lifestyle modifications, such as increased physical activity, weight loss and eating a healthful, low-glycemic, index diet rich in fibre, fruit and vegetables, may not only help prevent diabetes, but also reduce the risk of heart disease.’ This study was based on what’s called the Atherosclerosis Risk in Communities Study (ARIC). Analysing the data from this long-term program has helped to give us a clearer understanding of heart disease risks. Set up in 1987 to measure the associations of established and suspected CHD risk factors in men and women, it tracked almost 16,000 people from North Carolina, Mississippi, Maryland and Minnesota. Participants had four medical examinations (1987-90, and 1990-93, 1993-96, and 1996-99), and were contacted every year to update their medical histories.

In Selvin’s study reported in December 2005 Diabetes Care, her team looked at the ARIC data for 2,060 people with diagnosed and undiagnosed diabetes. The researchers identify several associations between HbA1c (a measure of long-term blood glucose) and known CVD risk factors and suggest that HbA1c is independently related to thickening of the carotid artery walls (a sign of heart and blood vessel disease). They conclude that: ‘chronically high blood glucose levels may contribute to the development of atherosclerosis in people with diabetes independent of other risk factors.’

photo: scott dickinson

Sense and SensitivityWriting in December 2005 Diabetes Care Liese et al report on the association of digestible carbohydrates, fibre intake, glycemic index and glycemic load with a number of factors including insulin sensitivity in 979 adults from the Insulin Resistance Atherosclerosis Study. The researchers analysed data from the study and estimated nutrient intake using a food frequency questionnaire and concluded that: ‘Carbohydrates as reflected in glycemic index and glycemic load may not be related to measures of insulin sensitivity, insulin secretion, and adiposity. Fibre intake may not only have beneficial effects on insulin sensitivity and adiposity but also on pancreatic function.’—Diabetes Care 28:2832-2838, 2005

GI Group: The food frequency questionnaire used in the study does not assess an individual’s carbohydrate intake very well. Comparison with another method of assessing an individual’s carbohydrate shows that the food frequency questionnaire has a very poor correlation ( just 0.37) for carbohydrates and thus it would be judicious to question the study’s conclusions.

Assessing a person’s food intake accurately is challenging. People tend to under-report some foods and overestimate others. There isn’t a perfect method. Food records, dietary recalls and list-type methods such as food frequency questionnaires are all subject to some error and bias. That’s why it’s important to assess the relative validity of estimates of nutrient intake statistically by comparison with independent methods to see how well they compare. The GI Group requires a correlation >0.5 for carbohydrate for these types of studies to be accepted and a recent paper published by the Harvard Group (Park et al. JAMA. 2005; 294:2849-57) corroborates this decision.

The average GI for the older Americans in the Liese et al study was 58, with a relatively small variation (standard deviation of 4). The relatively small variation would have meant it would be very difficult to find statistical differences between the groups with high and low insulin sensitivity, insulin secretion and adiposity. This may be because the food frequency questionnaire used does not measure carbohydrates well, or that their study population has a very similar diet from a GI perspective.

Interestingly, research in Australia shows a similar average GI for the older Australian population of around 56, and this appears to be pretty typical for those developed nations that have been studied. Although more research is needed, it appears that the average GI associated with the least risk of developing chronic lifestyle diseases like type 2 diabetes, heart disease and some cancers, is around the low to mid-40s as stated in the Liese et al study . The GI Group has previously suggested that individuals need to decrease the average GI of their diet by around 15 units and this is consistent with Liese et al.

White Bread MattersWhile many parents would prefer their children to eat high fibre, wholegrain bread they know their kids, particularly once they are at school, will be wanting sandwiches made with white bread like everyone else. Even with the best of intentions, parents generally find it’s hard to get the grainy or soy and linseed breads into children. Don’t give up trying. And don’t despair. There are now two low GI white breads (with published GI values) on Australian supermarket shelves and one in the UK. They are ideal to set children up with a sustaining breakfast and fill those lunch boxes with healthy sandwiches: George Weston Foods Tip Top UP EnerGI (GI 54), Goodman Fielder’s Wonder White Low GI (GI 54) and Warburtons All in One loaf (GI 49). They were specially formulated by the manufacturers in response to the growing recognition of the benefits of eating low GI foods in treating childhood obesity and preventing type 2 diabetes later in life. There are other benefits too. ‘Studies have shown that low glycemic index foods are an important part of a healthy diet for children as they supply them with sustained energy levels during the day, which helps maintain physical and mental concentration,’ says Prof. Jennie Brand-Miller from the University of Sydney’s Human Nutrition Unit.

Both the Australian breads carry the GI Symbol meaning they have had their GI tested using the accredited methodology and meet the strict nutritional criteria set out in the public health program run by the University of Sydney, Diabetes Australia and the Juvenile Diabetes Research Foundation. For more information visit: www.gisymbol.com

Sweet Beginnings—Agave Nectar Is the First US Product to Carry GI SymbolSweet Cactus Farms Premium Agave Nectar: (GI 19) is extracted from the pineapple-shaped core of the Blue Weber agave (Agave tequilana), a succulent plant (not a cactus) native to Mexico. It’s been cultivated for hundreds of years giving the world aguamiel, pulque, and tequila as well as agave nectar, a liquid sweetener. Premium Agave Nectar is around 90 percent fructose (which accounts for its low GI), and about 25 per cent sweeter than sugar so you don’t need to use as much. You can use it to sweeten food or drinks including tea and coffee. Sweet Cactus Farms says that if you are using it in your baking instead of sugar:

Soy Milk—a Great Way to Include Soy Protein in Your DietOnce enjoyed mainly by vegetarians, soy milk is the completely dairy- and lactose-free beverage that has become increasingly popular, because it tastes good and is rich in phytoestrogens. Soy milk is usually made by mixing soybeans – which are usually GM/GE free (check the label) – with filtered water and flavourings to produce a milk-like product.

You can buy reduced fat, calcium fortified soy milk GI 36–44 fresh from the chilled dairy cabinet, in long life packs and in powdered forms. You can also buy flavoured products. To ensure it is a suitable alternative to regular dairy milk, soy milk is often enriched with a range of vitamins and minerals including calcium and riboflavin (vitamin B12). Choose a low fat calcium-enriched milk and use it exactly as you would regular milk – on your breakfast cereal, with hot or cold drinks or in your cooking when making desserts and sauces. If you haven’t tried calcium-enriched low fat soy milk before, here are some easy ways to get started.

Mix it in with mashed sweet potato, pumpkin or potato; or in a combination of all three vegetables.

Try a soy latte or soy banana smoothie or use in other flavoured milk drinks.

Use it to make white sauce for lasagne or moussaka.

Make dairy desserts with soy milk.

—From Low GI Eating Made Easy (available in Australia, New Zealand, the UK and the US)

Sourdough French Toast with PeachesSimply halve the quantities to make for two people. For just one serving you’ll only need 1 peach and 1 slice of bread, but you’ll still have to use 1 egg, 125 ml milk and 2 teaspoons of maple syrup and you’ll have a little mixture left over.

1. Whisk the eggs, milk, maple syrup and nutmeg together in a shallow bowl. Lightly spray a non-stick frypan and heat over a medium heat.2. Dip the bread in the egg mixture and turn to coat completely. Place the bread in the heated pan and cook for 2–3 minutes on each side until golden brown. Set aside and keep warm.3. Spray the pan lightly again, and cook the peach slices for 1–2 minutes on each side, until just softened. Serve the French toast topped with the peaches.

Sanna’s Story: Giving Your Body the Fuel It Is Actually Meant to Run On‘I found out about GI in a food magazine in Sweden last year. I had never been on a diet, and cannot count calories if my life depended on it! But as I read in this magazine about the principles of eating with low GI, I thought, hey, I want to try! So I systematically exchanged my white flour, sugar, and potatoes to lentils, beans, veggies and dark whole grain bread. The results were immediate. Since my second daughter was only three months old when I entered my GI adventure, people were quite upset with me that I would “diet” when I was still breast feeding. But what I was doing was not dieting at all! I simply began eating more healthy, and my overweight just melted away. In three months I went from 72 kg to 64 (I am 166 cm), and I felt great! I happily continued to nurse my daughter until she turned one, and then I lost another 3 kg.

I feel energised, slim, healthy and HAPPY! Thank you for spreading the word about GI! It is not hard at all! I never go hungry, and I don't skip meals to try to force myself to lose weight (that most often leads to later binging anyway). In the beginning it was quite a challenge to overcome the sugar pull, because that stuff is as addictive as anything! But now I don't even crave it anymore! I am free!

Try it out you too! Find a friend, and walk the GI road together. It is great to have someone to encourage you, and with whom you can exchange new exciting GI recipes. You will not want to go back once you have experienced the enerGi boost of giving your body the fuel it is actually meant to run on!’

Sanna

John’s Story: Managing Diabetes with GI‘Having just finished reading The New Glucose Revolution I would like to share with you my success in managing diabetes with a GI diet. I am 64 and was diagnosed diabetic at the end of May 2005. I was admitted to hospital very ill – blood pressure 256/149; HBA1C 13.2; blood glucose 11.4; cholesterol 7.2; weight 113 kg.

For several months I had been ill and showed all of the typical symptoms of diabetes – weight loss, craving for sweets, continual need to urinate etc. But being a typical male I refused to seek treatment until my condition was chronic. After five days in ICU and three in a recovery ward I was discharged with my blood glucose at 8.2 mM, blood pressure controlled by medication and using Lantus 24 ml daily. Other medication was Tritace 10 mg, Lipitor 20 mg and Ecotrin 81 mg (which I had been taking for 15 years) daily and Glucophage 500 mg bd. Fortunately, scans and tests revealed no abnormality to heart, lungs, liver and kidneys. Eyesight had deteriorated but has since restored itself and all pulses and nerves to extremities were normal. Eyesight has since restored itself and I use the same reading glasses I used before diagnosis.

After having visited one of the South African diabetic associations, which was a disaster, I found out about the glycemic index and started the diet. Having now read several of your publications and visited many websites I have adopted this as a lifestyle and have adhered to it for 6 months and intend to do so for the rest of my life. I have found the experience stimulating and fulfilling and limitations on dietary requirements minimal. In addition I have a regimented regular exercise program of a minimum of 30 minutes, 5 days a week on a treadmill at 6 km per hour. Over the past 6 months I have reduced my insulin requirements and for4 weeks now have stoped all insulin injections. Random blood glucose readings vary between 4.5 and 6.4 mM and this week I underwent my biannual medical the results of which are as follows. Blood pressure 126/74, HBA1c (glycated) 5.5, cholesterol 3.27, LDL 1.24, HDL 1.57. All liver, kidney and urine tests normal. ECG normal. Weight 100 kg. I believe this is testament to the success in low GI foods in the control of type 2 diabetes. Thanks for all your research and long may it continue.’

Prof Jennie Brand-MillerIn this occasional series, we ask some of the world’s leading GI researchers to tell their story. This month we look at the University of Sydney’s GI Group leader, Prof. Jennie Brand-Miller’story. What follows is an edited version of her Australia Day 2006 speech. Jennie is acknowledged worldwide for her expertise in the area of carbohydrates and health. Since 1981 she and her team have played a key role in establishing the scientific validity, benefits and practicalities of the glycemic index. Jennie is Professor of Human Nutrition at the University of Sydney. She holds a Personal Chair in the Human Nutrition Unit of the School of Molecular and Microbial Biosciences. Her research interests focus on many areas of nutrition – the glycemic index of foods, diet and diabetes, insulin resistance, lactose intolerance and infant nutrition. But Jennie has another story to tell.

Jennie Brand-Miller

‘Eight years ago I was ready to resign from my job and felt like resigning from life. I had worked hard at school, got a scholarship to the University of New South Wales, did a bachelor’s degree and then a PhD and landed my dream job at the age of 25 – a lectureship at the University of Sydney. But not everything was going my way, there were black clouds on the horizon. Slowly but surely, over the course of 25 years, I lost the hearing in both ears. Today I am profoundly deaf. The decline in hearing was an emotionally painful process. I was excruciatingly embarrassed. I dreaded being considered stupid, especially in a world of intellectuals at the university. I learned to avoid difficult hearing situations. Any gathering of people, any meeting, any noisy environment, was stressful. The telephone became a source of great torment. People's names escaped me and transcribing numbers, addresses and dates became impossible. I gradually lost the ability to enjoy television and movies. Public address announcements were impossible.

But since 1998 my life has done a complete ‘about face’. How come? I was given the gift of hearing – a cochlear implant or bionic ear – something only possible because of the achievements of Professor Graeme Clark. Graeme Clark developed the world first bionic ear from an early prototype to successful commercial venture (go to http://www.cochlear.com/). The cochlear implant was like jump leads to a car with a flat battery. Suddenly I had more confidence, more energy, more self-esteem and I was so proud of the cochlear implant and the fact that it was Australian technology. Instead of being humiliated by my hearing loss, I was suddenly proud of it and I what I could do. I wanted to tell everybody about my bionic ear. And I do.’

The 10-day GI DietAzmina Govindji RD and Nina Puddefoot‘Feed a man fish and he eats for a day. Teach a man to fish and he eats for life.’ This 10-day diet is intended as a ‘kick start to a new healthier you.’ Despite the ‘lose up to an inch’ promise of the sub-title, the authors are well aware that it is just a beginning. Not a miracle. The idea is to get you enthused and then hooked on healthy eating. It’s not GI, it’s GiP, a special system that the authors have devised based on nutritional criteria that encompass a food’s GI, energy density (calories/kilojoules) and portion size – special GiP tables are in the book. So there are numbers or GiPs to keep a count of and add up each day. But, it’s well written and packed with practical tips, menus and some 60 healthy recipes made with low GI ingredients you can get on the table in around 20 minutes.—Vermilion, £6.99

The Low GI Guide to Your Heart and the Metabolic SyndromeProf Jennie Brand-Miller and Kaye Foster-PowellScott Dickinson, GI News designer and web manager who is also completing his PhD on glycemic index and cardiovascular disease risk, thinks that this is the best little book on GI out there. ‘Short, succinct and easy to understand’ is how he describes it. It covers the benefits of GI for heart health, includes practical tips to help readers make the switch to low GI eating and sets out the 10 basic steps to a healthy heart diet along with a week of menus to get you started. Recognising that metabolic syndrome is a world-wide problem, this completely revised and updated edition of the pocket guide by the same name includes more than 100 Chinese, SE Asian, Indian, Mediterranean and Middle Eastern meal ideas from dietitians Johanna Burani, Linda Cumines, Effie Houvardis and Sangita Nayak.

What effect good or bad, can a GI diet have on prostate cancer patients undergoing hormone treatment to limit testosterone?We couldn’t find any published research on the links between the GI of your diet and hormone treatment for prostate cancer patients to limit testosterone. There are however, well established dietary guidelines for men to reduce their risk of prostate cancer by reducing the amount of red meat and high-fat dairy foods they eat and making sure they eat five or more servings of vegetables and fruits each day. Reducing the GI of your diet is now added to the ‘reduce the risk’ list as prostate cancer has been linked to high circulating levels of insulin. A study from Italy and Canada reports a direct relationship between dietary GI and GL and prostate cancer risk – men whose diets were highest in GI and/or GL were more likely to develop prostate cancer even after adjusting for all other factors. The researchers explain that low physical activity levels together with high GI carbohydrate and hence higher blood insulin levels were likely responsible for the increased cancer risk (International Journal of Cancer ( 2004; 112(3):446-50). The strength of this particular study is the large number of participants and controls and the use of a reproducible and validated questionnaire. For additional information, contact Claudio Pelucchi, Istituto di Ricerche Farmacologiche Mario Negri, Via Eritrea 62, 20157 Milan, Italy. E-mail: pelucchi@marionegri.it.

I enjoy brown rice and always assumed it had a lower GI than any kind of white rice, but I see that Basmati’s is lower. Why’s that?The GI group is on the hunt for a brown low GI rice – stay tuned! Rice can have a very high GI value, or a low one, depending on the variety (there are around 2000 varieties worldwide) and its amylose content. Amylose is a kind of starch that resists gelatinisation. Although rice is a wholegrain food, when you cook it, the millions of microscopic cracks in the grains let water penetrate right to the middle of the grain, allowing the starch granules to swell and become fully ‘gelatinised’, thus very easy to digest. So, if you are a big rice eater, opt for the low GI varieties with a higher amylose content such as Basmati. These high-amylose rices that stay firm and separate when cooked combine well with Indian, Thai and Vietnamese cuisines.Brown rice is an extremely nutritious form of rice and contains several B vitamins, minerals, dietary fibre and protein. Chewier than regular white rice, it tends to take about twice as long to cook. The varieties that have been tested to date have a high GI, so enjoy it occasionally, especially combined with low GI foods such as legumes.

Sushi rice (Koshihikari rice GI 48) is a short-grain rice with a slightly, sticky soft texture when cooked. Wild rice (GI 57) is not actually rice at all, but a type of grass seed.Arborio rice releases its starch during cooking and has a medium GI.

Does it matter if you eat carbs after 5pm? Will this affect your fat metabolism? The first point to make is that people with diabetes who are taking insulin or other blood glucose lowering medication should definitely not practice a carb curfew – they could develop a hypo. The second point is that there’s no scientific evidence yet to support the carb curfew theory. It’s certainly not endorsed by health authorities.

‘I think the “carb curfew” myth for weight loss arose from the body builders on one their pre-competition regimes,’ says dietitian Catherine Saxelby (www.foodwatch.com.au). ‘They are heavily into protein and denial and usually follow a semi-fast before a competition to remove surface fat and better define their muscles. Cutting out carbs like potato, pasta or rice with dinner is simply a way of cutting down on kilojoules (calories). That’s all. Here’s what you’ll save:

Cut out a large baked potato and you reduce your dinner intake by 580 kilojoules.

Cut out a cup of steamed white rice and you’re down 770.

Cut out a cup of cooked spaghetti and you’re down 840.

So out of a total dinner intake of say 1200 kJ for grilled steak, potato and a salad, you can knock off over 50% if you say No to the carbs. That’s why you lose weight! But there’s no point in eating an unbalanced meal – it only sets you up to snack the night away because you’re still hungry. A steak or fish fillet with non-starchy vegetables is not a balanced meal. Add a small carb portion and you’ll feel a lot better and you’ll feel satisfied. Just half of cup of rice or pasta or a small potato or even a slice of grainy bread will balance things out nicely.’

Dispelling some myths about … Hypoglycemia

Hypoglycemia is a condition in which the glucose level in the blood falls below normal levels. It derives from the Greek words “hypo” meaning under and “glycemia” meaning blood glucose – hence blood-glucose level below normal. People with diabetes know all about it. If you don’t have diabetes, but you have vague health problems ranging from tiredness to depression and think you may have hypoglycemia or someone tells you that you probably have ‘low blood sugar’, see your doctor and get a proper diagnosis.

Hypoglycemia is far less common that once was thought in people who do not have diabetes.

Hypoglycemia due to a serious medical problem is rare.

The most common form is reactive hypoglycemia, which occurs after eating.

What you need to know about reactive hypoglycemiaWhat is it?If you have reactive hypoglycemia, it means that your blood-glucose level rises too quickly after you have eaten causing the release of too much insulin. This then draws too much glucose out of the blood, your blood-glucose levels fall below normal and you suffer a variety of unpleasant symptoms from sweating, tremor, anxiety, palpitations, and weakness to restlessness, irritability, poor concentration, lethargy, and drowsiness.

How is reactive hypoglycemia diagnosed?Diagnosis is difficult because there are no clear diagnostic criteria. Your doctor may:

ask you about signs and symptoms

test your blood glucose while you are having symptoms (The doctor will take a blood sample from your arm and send it to a laboratory for analysis. A personal blood glucose monitor cannot be used to diagnose reactive hypoglycemia.)

If your doctor uses an oral glucose tolerance test (OGTT) to diagnose hypoglycemia you have to continue it for at least 3-4 hours (the normal time is 2 hours). Your insulin levels would be measured at the same time.

How is it treated?The aim of treating reactive hypoglycemia is to prevent sudden large increases in your blood-glucose levels so you won’t produce excessive, unnecessary amounts of insulin and your blood-glucose levels will not plunge to abnormally low levels.

You can achieve smooth, steady blood-glucose levels by changing from high- to low-GI foods. This is particularly important when eating carbohydrate foods by themselves. Low GI foods like wholegrain bread, low-fat yogurt, and low GI fruits are best for snacks. If you can stop the big swings in blood-glucose levels, then you will not get the symptoms of reactive hypoglycemia and chances are you will feel a lot better.—Source: The New Glucose Revolution